As the COVID-19 pandemic has demonstrated, barriers to vaccination uptake are heterogeneous and vary according to the local context. We argue that a more systematic consideration of local social and behavioural mechanisms could improve the development, assessment and refinement of vaccination uptake interventions. The EBM+ approach to evidence appraisal, which is a development of a recent line of work on the epistemology of causality, provides a means to evaluate mechanistic studies and their role in assessing the effectiveness of an intervention. We argue that an EBM+ methodology offers several potential benefits for research on vaccination uptake interventions. It also motivates the use of detailed mechanistic models, rather than the high-level logic models used by process evaluations, for example.
Immunisation is an integral part of global healthcare provision. It has helped to drive a massive reduction in worldwide annual child (under the age of 5) mortality, from 9.6 million in 2000 to 5.4 million in 2017 (WHO 2013; UNICEF 2018). It is estimated that annual deaths from just 5 vaccine-preventable diseases (diphtheria, measles, neonatal tetanus, pertussis and poliomyelitis) have dropped by 0.5 million a year since 2010. Vaccination coverage is one way of continuing to progress these achievements. There are licensed vaccines for 27 diseases, and to be licensed requires demonstration of efficacy. But…
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